Category Archives: Health Care

Hey, Governor, How About the Rest of Us?

by James A. Bacon

Having expanded Medicaid coverage for more than 325,000 Virginians, Governor Ralph Northam now has issued an executive order directing actions to increase the number of Virginians enrolled in “quality, affordable health care coverage.” Secretary of Health and Human Resources Daniel Carey will explore ways to expand Medicaid enrollment, reduce insurance premiums, increase transparency of insurance choices, and develop a “data-driven strategy to create efficiencies in coverage and improve outcomes” with a special focus on “vulnerable” populations.

We won’t know what these initiatives will cost the non-vulnerable (the vast majority of Virginians) until we see the proposals. But as Carey undertakes his inquiries, he and the Governor would be well advised to remember how much health care in the form of Medicaid is already costing the state.

State General Fund spending on Medicaid services has increased from $2.29 billion in Fiscal 2010 to $4.88 billion in Fiscal 2019, according to a recent update on state spending by the Joint Legislative Audit and Review Commission. That was an annual growth rate of 9% yearly, and it accounted for 39% of the growth of all General Fund spending, crowding out other priorities.

Meanwhile, the Kaiser Family Foundation has found that the average cost of employer-provided family health care coverage now exceeds $20,000 a year, with workers paying slightly more than $6,000. That’s a 5% increase from last year — and it doesn’t take into account steadily rising deductibles and co-pays. Middle-class Virginia households are caught in a triple whammy — supporting ever-inflating Medicaid costs, paying more for their own insurance, and paying more out-of-pocket. Continue reading

So Much Health Care Data, So Little Actionable Information

Palliative care grades by state. Source: released 2019 “State-by-State Report Card on Access to Palliative Care in our Nation’s Hospitals”

by James A. Bacon

There are many ways to gauge the quality and cost-effectiveness of Virginia’s hospitals. One is to measure cost and efficiency. Another is to track mortality rates and re-admissions. Yet another is to rate patient satisfaction. You can find these metrics on the Virginia Health Information website.

But health care is a phenomenally complex business, and many other aspects of hospital care are measurable. In a recent press release, the Virginia Hospital & Healthcare Association (VHHA) pointed out, for instance, that Virginia is one of 20 states (and Washington, D.C.) to earn an “A” for palliative care, based on a study by the Center to Advance Palliative Care and the National Palliative Care Research Center.

What is palliative care? It is, according to the report, “specialized medical care for people living with a serious illness. It is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness.”

Having witnessed the lingering deaths of a step mother and father-in-law in recent years, I get it. The goal should not be to prolong life at any cost but to improve the quality of life that remains. Continue reading

Dems & Dom, RGGI Grows, Medicaid & Work

By Steve Haner

What Was Lost Is Found Again.  Couldn’t they wait at least another few weeks?  Anybody foolish enough to believe that Dominion Energy Virginia and the Virginia Democratic Party establishment have really parted ways (as Jim Bacon seemed to think a while back), take note of this from today’s Richmond Times-Dispatch:   Governor Ralph Northam’s new communications director, Grant Neely, is totally plugged into the Dominion Energy/Richmond’s Navy Hill/Mark Warner and Bob Blue nexus.  You can fool some of the people some of the time, but certain Democrats just about any time you want.

Source: Philadelphia Inquirer

The P in PJM Now Joining RGGI.  Pennsylvania Governor Tom Wolf, a Democrat, has signed an executive order that his state should be the next to join the Regional Greenhouse Gas Initiative.  According to this from The Philadelphia Inquirer, the executive order route comes after being rebuffed by the legislature.  It is a strong first step but not a done deal, with litigation one possible route for opponents.  Virginia’s on-hold membership will likely be determined by the General Assembly elected next month.

Continue reading

Will These Insurance Ads Also Sway VA Voters?

“You Only Pay For What You Need”

By Steve Haner

As the state campaign debate rages about health insurance plan which are short term or less comprehensive than the Affordable Care Act, two  on-going national ad campaigns may cross-pollinate the debate.  They are bolstering the Republican position nicely.

The first are the spots with people saying they are worried about the various Medicare for All proposals. They express concerns about a more expensive one-size-fits-all approach. Well, isn’t that exactly what Democrats like Senate candidate Debra Rodman and other others are demanding in Virginia? One size fits all? In several districts they are attacking Republicans who voted to allow lower cost alternatives that didn’t offer all ACA features.  Continue reading

Don’t Abandon Medicaid Work Requirement

Cover art from 2014 JLARC report on Virginia’s array of workforce training programs. Another state report notes almost 860,000 served in 2017.

By Steve Haner

To Republicans who supported the 2018 decision to expand Medicaid services to more Virginians – and encouraged yes votes from reluctant colleagues — the promise to couple those benefits with pathways toward gainful employment was a key reason. The compromise has worked in other states as well.  Continue reading

Medicaid Expansion Cost Still Off-Budget, Elusive

By Steve Haner

All the signs point to trouble. The next state budget, a two-year plan to be proposed in December, adopted by March and implemented in July, may be caught between stagnant revenue and soaring spending.  The spending charge will be led once again by Medicaid.

Just how much the decision to expand Medicaid will cost in the future remains elusive.

The state’s fiscal prospects were explained to the General Assembly’s money committees September 16 and 17 by Secretary of Finance Aubrey Layne.  The highlights are summarized in this article for the Thomas Jefferson Institute for Public Policy, using the image of a strand of worry beads.  The article is being distributed today.  Continue reading

Updates on the Rural Health Care Crisis

by James A. Bacon

It turns out there’s not just a hospital shortage and a physician shortage in rural Virginia — there’s a nursing shortage. A couple of articles over the weekend highlighted growing problems with health care access in rural and small-town western Virginia communities.

Community leaders in Patrick County have given up on bringing back a local hospital from the dead, reports the Associated Press. Efforts to resuscitate the old Pioneer Community Hospital were hampered by complex licensing issues and the high cost of retrofitting the 1960s-era hospital building, which has deteriorated since it closed two years ago and suffers from extensive deferred maintenance issues.

Local officials now are looking for other ways to deliver health care services to the mountainous county where the population is declining and aging, the AP says. In the meantime, still-functioning hospitals are shutting down floors and units due to an inability to staff them with nurses. Continue reading

There Is a Line and These Two Crossed It

The silly season is in full swing.   Stop believing (in fact, maybe stop reading) the political trash coming into your mailbox, inbox or showing up online. Television you already know not to trust, right?  Someone told me that political ads have invaded streaming services now, which is depressing.

It was Democratic senate candidate Debra Rodman’s television ad attacking Henrico County Senator Siobhan Dunnavant that sparking this post.  I was really put off by the opening, where Rodman expresses her respect for Dunnavant’s medical skills, and then claims the obstetrician has “forgotten” what it is like to be a patient. “Wow, that’s pretty nasty,” was my first thought.  It gets worse.  Continue reading

National Dark Money Campaign Sloshes into Virginia

Rep. Ben Cline — one of 50 Congressmen targeted by $28 million dark money campaign

A lot of things are happening in our dysfunctional health care system outside the public view. But every so often, a piece of flotsam pops to the surface that reveals the rent-seeking behavior by private interests in a system regulated at every level by government. The latest revelation concerns two private equity-backed physician-staffing groups behind a $28 million national ad campaign aimed at pressuring members of Congress, including Rep. Ben Cline, R-Rockbridge.

This particular incident also illustrates the role of dark money in our political system. Rather than influence elected officials directly by contributing to their campaigns, this initiative sought to pressure them by influencing their constituents.

By way of background, many hospitals — including those in Virginia — staff their emergency departments with physicians who belong to TeamHealth, Envision Healthcare, or other groups that specialize in operating emergency rooms. Emergency medicine is a specialized niche, and these firms claim to do a better job of managing emergency rooms than most hospitals can themselves. This TeamHealth white paper describes how outsourcing can “transform” hospital emergency departments when “patient flow is crawling, outcome measures are flagging, and there’s bad blood among physicians.” Continue reading

More Reason for Cynicism about Medicaid Expansion

Sentara Norfolk General Hospital: emergency room admissions up 7%

by James A. Bacon

More than 300,000 Virginians have something today they didn’t have last year — health insurance through Medicaid, observes Virginia Public Radio. What they don’t have is a primary care physician. Many are still seeking primary care treatment at hospital emergency rooms.

Admissions to the emergency room of Norfolk General Hospital have increased 7% this year. One hoped-for benefit of Medicaid expansion is that more patients would seek treatment outside the emergency room, one of the most expensive settings for medical treatment. Clearly, that benefit has not materialized. “There’s a whole behavior modification and teaching and education that needs to happen,” says Sentara Norfolk General President Carolyn Carpenter.

Yeah, that…. and there’s a Medicaid-patients-finding-a-doctor thing that needs to happen, too. Due to low reimbursement rates, many primary care physicians cap the number of Medicaid patients they treat.

One would think that Governor Ralph Northam, a physician, would appreciate this. But other than allowing more latitude for nurse practitioners to treat patients, I have seen no remedies proposed by Virginia’s ruling class to address the most significant of all barriers to health care. The inaction calls into question how serious people really are about expanding real health care coverage for the poor. Continue reading

SCC Told It Lacks Authority to Limit Balance Billing

by Steve Haner

The arguments which have paralyzed Virginia General Assembly efforts to end surprise bills from medical providers are surfacing again in comments to the State Corporation Commission.  It is considering an internally generated regulation that requires advance consent from patients to be treated by someone outside their approved health plan.

As proposed in June and reported by the Richmond Times-Dispatch, the regulation addresses only elective medical procedures, not emergencies.  It is tied to legislation which passed in 2019 that requires written notice to patients of the possibility some provider on their care team might be “out of network” and thus send them a separate bill outside their insurance contract.  Continue reading

Danville Free Clinic Bites the Dust

by James A. Bacon

Before Virginia embarked upon Medicaid expansion, the state had a network of free clinics that provided primary-care services to people lacking health insurance. It was an imperfect safety net, to be sure, but at least it was something. Now, more than a half year into Medicaid expansion, that safety net is fraying in places.

The Free Clinic of Danville has closed its doors after experiencing a sharp drop in patient volume, reports In operation since 1993, the clinic survived on state grants, local foundation grants, private donations, and volunteer labor.

The drop in patients following Medicaid expansion was felt almost immediately. The clinic, which had 187 patients at the end of 2018, had only 15 by July. The remaining patients are being transferred to Piedmont Access to Health Services (PATHS), the SOVAH Family Medicine Residency Clinic and other providers. Continue reading

Medicare for All? Medicare for Us Is Different

Power (And Free Stuff) For the People!

Blame this one on four wasted evenings watching the Democratic presidential debates.  As Senators Bernie Sanders and Elizabeth Warren and the rest were describing their promise of “Medicare for All,” my wife and I were deep in the process of learning about and registering for “Medicare for Us,” which kicked in this month.

The big discrepancies between the two inspired my column (here) in today’s Richmond Times-Dispatch.

The debate over health care policy and payment systems is a perfectly valid one for national politics.  Everyone sees the problems.  Like it or not the country is about half-way, perhaps more than half-way, to a fully federalized health care system.  Medicare, Medicaid and the military-related programs covered about 33 percent of Virginians in 2018, and federal regulations including but not limited to the Affordable Care Act dictate many policies for the rest of that sector.   Both political parties have added to the structure.  Continue reading

Health Insurance Check-Up; Migration to Medicaid

Number of carriers selling individual health insurance policies for next year by locality. Most places have only one or two. Source: SCC. Click for larger view.

The number of Virginians buying health insurance as individuals is shrinking and may shrink more, with two trends getting most of the credit:  Expansion of Medicaid eligibility and a change in the law that allowed those in business as sole proprietors to buy policies in the small group marketplace.

Individual coverage peaked at 418,000 Virginians in 2016 and dropped to 300,000 by March of this year.  The projection for 2020 is about 303,000 covered that way, the State Corporation Commission was told in a presentation on the health insurance market released July 18.  You can see the full presentation here. Continue reading

Magnifying Partisan Research with a Partisan Spin

Photo credit: Washington Post

Social scientific studies are increasingly infected by ideological bias and a crisis of unreplicable results. Compound that with the ideological bias of the mass media, which spin findings to advance their own partisan narratives, and you get articles like this one from the Washington Post: “Trump’s presidency may be making Latinos sick.

Trump’s presidency may be making some people sick, a growing number of studies suggest. Researchers have begun to identify correlations between Trump’s election and worsening cardiovascular health, sleep problems, anxiety and stress, especially among Latinos in the United States. A study published Friday using data from the Centers for Disease Control and Prevention found the risk of premature birth was higher than expected among Latina women following Trump’s election.

This is the same kind of junk reporting of tendentious science that we see increasingly in Virginia, where newspapers report on “studies” showing “correlations” that supposedly demonstrate the existence of systemic institutional racism. It’s not impossible that some of the studies are valid. But they need to be subjected to much closer scrutiny before being accepted and propagated widely, as they invariably are. Continue reading